55877 prior authorization | Anthem Blue Cross Blue Shield of California

55877, Ablation, irreversible electroporation, prostate, 1 or more tumors, including imaging guidance, percutaneous, is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: 55877
Description: Ablation, irreversible electroporation, prostate, 1 or more tumors, including imaging guidance, percutaneous
Source: California PPO Prior Authorization List, Pg 9 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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